Do masks promote a false sense of security?

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With the CDC reversing their guidelines and now recommending that the general public wear masks, many states are quickly requiring them. While wearing a mask is something tangible that people can do to feel safe and makes for a nice post on Instagram, they will, unfortunately, do little, if anything, to stop this pandemic. In fact, this crisis will only worsen as people begin taking non-essential trips, with the false belief that they are safe because they are wearing a mask.

We have already seen the public struggle to use protective equipment as simple as gloves. Now a fashionable item at grocery stores, they do not provide much protection to the wearer when the same dirty pair that was used to push their cart is also used to touch their phone, their face, and eat a snack. The Cleveland Clinic, which is recommending against wearing gloves in public, recognized another glaring issue; most people cannot safely remove them without contaminating themselves.

Masks pose an even larger problem. Anyone who has worked in an emergency department has had to tell a sick patient that their mask needs to cover their nose as well as their mouth. We have all seen unfitted N95s worn over beards or with incorrect strap placement.

Considering the public cannot use manufactured equipment correctly, one must ask how the fundamentally inferior homemade masks will compare. Without additional filters, cotton masks are only 4.5 percent to 56 percent as effective at protecting the wearer as surgical masks, which are themselves inferior to N95s. Although widely unavailable, N95 masks remain the CDC recommendation when caring for unmasked COVID-19 patients. While homemade masks may perform better as source control, the CDC admits that they lack evidence as to their efficacy at preventing transmission to others.

Although new data shows promising results with some fabrics, the CDC’s vague recommendation of cotton fabric or bandanas means many people will be wearing masks that are effectively equivalent to no mask at all.

Even with better instructions for materials selection, few know how to properly don and doff a mask, perform hand hygiene, or have heard of sanitizer contact times. Not only is this a risk to the wearer, but a recent study also found more contamination on the outside of masks worn by COVID-19 patients than the inside. As a result, the same mask meant to prevent disease could become another vector for transmission.

The most dangerous aspect of masks is psychological, allowing people to enter a fantasy of normality even when we are far from it. While we may be past our current peak and have some additional testing capability, fundamentally, nothing has changed. This outbreak spread from only a few people, so with no vaccine, herd immunity, or effective treatment, there is nothing preventing a second wave of infection in which thousands more could die.

And it is not just the public falling into this trap, but politicians such as New York’s Governor Andrew Cuomo. Although he has been praised for his COVID-19 response, he repeatedly spoke out against closing public transit, issuing shutdowns, and initially prevented New York City from doing so, claiming, “Fear is as or more contagious as the virus.” In New York City, where 2 of every 1000 residents have died of COVID-19, Bill De Blasio similarly fought to keep the schools open as the crisis loomed. It is these same politicians who are now beginning to lift restrictions in New York and already discussing a more broad reopening.

The economic impact on business has created a huge pressure on governments to reopen, and some politicians are willing to blatantly risk the lives of their constituents to do so. Las Vegas Mayor Carolyn Goodman offered Las Vegas as “a control group” for reopening and proposed a free-market solution to public health, saying that if business opens and people get sick, “competition will destroy that.” Texas’s Lieutenant Governor Dan Patrick recently justified reopening by saying, “there are more important things than living.”

Masks will only worsen this trend as they give other politicians the political and moral cover to follow the same path, under the fantasy that they are protecting their constituents with public mask use and social distancing.

In theory, social distancing sounds possible, as the CDC says the public should be safe even without effective PPE, as long as they keep 6 feet away from those around them. However, even when ignoring a recent study that showed COVID-19 might be able to travel through the air as far as 13 feet, the public does not seem to grasp the concept of social distancing.

While stores are requesting patrons keep 6 feet apart from those in line, many people still stand shoulder to shoulder between check stands or in narrow store isles. They continue to crowd onto mass transit and are beginning to pack parks and beaches. Many see the 6-foot rule as a game, looking for loopholes to exploit rather than trying to protect themselves, something that will only be worsened with the perceived safety of masks.

As health care workers, we have to do a better job to publicly counter this narrative that we can safely reopen, and I don’t just mean on social media. While masks may help reduce transmission, the takeaway message for the public must be that masks will not keep them safe, they will only lower their risk.

What we need to promote is personal responsibility. Every time that someone leaves their house, goes to the store, or orders take-out, they are taking a risk that may get themselves or loved ones sick. And we need to ask ourselves if that trip to the beach is worth that risk.

We all want to return to our jobs, our friends, and share a new #COVID19 post. But we are at war, and this is one of those times when people need to be asked to sacrifice for their country. Today what that means is to stay at home, wash your hands, and be patient.

Daniel Berger is a medical student.

Image credit: Shutterstock.com

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